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Sylvia Rineair
Questions from Cincinnati Children's VAT
At CCHMC, we are interested in finding out information about the following things:
-Pricing for CVC, PICC and PIV charges from other institutions such as PIV insertion with phlebotomy,PIV insertion with ultrasound, PICC insertion with ultrasound, CVC repair
- Do other institutions do CVC monitoring and if so, what does monitoring entail?
-Number of PICCs placed(average) per month?
-Does your team  provide  24/7 PICC insertion service? If so, do you shift the hours or cover with call hours?
-How would you describe your PICC reporting structure, i.e. who do your PICC
RN's report to---an MD or an RN? Interventional Radiology?
-How do you cover weekend PICCs when a nurse is unsuccessful?
-Do you have a physician who oversees your program?
-Are your PICC's placed at the bedside, or in IR?
- Do you sedate for PICCs?
At CCHMC we have a comprehensive Vascular Access Team that encompasses PIV,CVC and PICC services.  PIV is our newest addition.  We place about 160 + PICCs a month with 99% being placed in Interventional Radiology. Less than 5% of the patients are sedated.  We do have a full time Child Life specialist who is present at each insertion. At CCHMC, there are on average 130 patients a day with various devices that require CVC monitoring.  We provide 24/7 call coverage for all services at this time. Our volume continues to increase and we are looking for some information from peers as we try to restructure our program to manage the increased volume and needs of our patients. Any answers that you can provide will be appreciated.  Thanks in advance for your help.
Angela Lee
I will try to answer as many

I will try to answer as many questions as I can.

We place 40-50 PICCs per month.  We do not have IR--all the PICCs are placed by the PICC team which has 2 FTE and 2 .5 FTEs.  Unfortunately, right now there is only one position filled so it is a team of one (me).  Coverage is supposed to be 10 hrs/day with on call coverage on Fridays but needless to say my days are a lot longer than that.  I also do difficult PIVs and consult for PICC/CVL issues.  There is no weekend coverage so patients wait until the following Monday. There is no service charge for PICC placement other than how it falls under our RVU system for nurses time.  PICCs are placed at the bedside, in the treatment rooms on the units for infants and toddlers and in the sedation room for those being sedated.

We sedate as needed--can't give you a percentage off the top of my head but it is based on the patient assessment.

We have a medical director (surgeon) who is available for problems but we function independently.  We are housed under Nursing Education and Research (don't ask how that happened) but we are the only clinical folks in that department.  We report to the director of that department.

There is not the staff for effective CVC monitoring.  PICC follow up is also a problem.

Our infection control nurse monitors the infection rates in the ICUs.

It looks like you are at a pediatric facility but I can't tell which one.  Where are you?

It seems that many teams are in the same boat--too little staff for the amount of work and the increasing demands.  I fail to understand why the value of a properly staffed vascular access team is not understood.

Good Luck.

Sylvia Rineair
Thanks Angela!  I
Thanks Angela!  I appreciate your input. Sylvia
Angela Lee
Oops, never mind my last

Oops, never mind my last question--I saw the answer when I looked again at your post and saw the heading.  That's where I thought you were.

Angela

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